High dose Arm (HD): 64.8 Gy /1.8 Gy fractions with the same chemotherapy as above

169 patients participated in the quality of life (QOL) assessment with pretreatment characteristics balanced in both arms.

QOL was assessed using the Functional Assessment of Cancer Therapy, Head and Neck (version 2)

This was a self assessment using 5 subscales: physical well being, social/family well being, relationship with their physician, functional well being, and emotional well being

Assessment was done pre-treatment, post-treatment, 8 months after the initiation of treatment, and 1 year after the initiation of treatment, then every 6 months until year 5.

Results

3 year analysis of RTOG yielded no difference in survival. The reason for this negative result was the number of treatment deaths, which occurred in 11 (11%) of those in the high dose arm vs 2 (2%) in the conventional arm. However, all deaths occurred prior to 50.4 Gy.

Pre-treatment analysis: Patients were most concerned about pulmonary status. Females had a decreased QOL compared to males, which was more pronounced in the HD arm. Pre-treatment weight loss and squamous cell histology were also correlated with decreased QOL.

8 month post-treatment analysis: 73 patients (43%) participated (most common reason for dropout was patient death). QOL returned to baseline, while head and neck concerns improved to better than baseline in both groups. There was no difference between the HD and CD arms. There was no significant effect of gender on QOL scores.

1 year post-treatment analysis: 57 patients (34%) participated. Again, there was no difference in QOL between the two arms.

Author's Conclusions

Female gender and weight loss correlated with worse pre-treatment QOL

QOL scores decreased in both groups after treatment when compared to pre-treatment. Total QOL scores were significantly worse in the HD arm.

By 8 months, these QOL scores returned to baseline, but only improved in areas of head and neck concerns. There was no difference in QOL at 8 months or 1 year between the two groups.

Clinical/Scientific Implications Control of esophageal cancer is poor. The best nonsurgical results have been seen with concurrent chemoradiation to a dose of 50.4 Gy. However, many believe dose escalation to >50.4 Gy would result in better tumor control and survival, however, there is a question as to whether this can be safely done.
This study indicates, as expected, that QOL scores decrease after treatment, almost certainly due to acute toxicity of treatment. Again, as expected, this was significantly worse in the HD arm.
QOL scores were improved by 8 months, with the conclusion that, although acute toxicity is worse with higher doses of radiation, after these acute toxicities resolve, QOL is equal in both groups. This is encouraging, but unfortunately, 1 year out of treatment is too early to gauge chronic (long term) effects. This is a large concern with higher doses, especially when concurrent with chemotherapy. This could be especially enhanced in this group of patients, since cisplatin is such a radiosensitizing agent. Therefore, these results should be taken with some caution.

Mar 17, 2010 - Compared with standard-dose radiation, high-dose radiation treatments for localized prostate cancer are not associated with increased long-term treatment-related outcomes for urinary, bowel and sexual functions affecting quality of life, according to a study in the March 17 issue of the Journal of the American Medical Association.